brain injury etc

Question 1

head injury

Answer 1

Involves trauma to scalp, skull, and brain
—Result: mild concussion to coma to death
—Traumatic brain injury (TBI)

Question 2

TBI

Answer 2

Can be open, closed, diffuse, focal
Most common cause: falls
Older adults, infants, school-age kids, young adults with risk-taking behaviors

Question 3

Clinical manifestations of head injury

Answer 3

Depend on location and severity of injury
—Symptoms of hemorrhage are delayed until hematoma is large enough to increase intracranial pressure
Hematoma: large collection of blood, can often be removed
Can involve personality as well as physical function

Question 4

hemorrhage head injury *epidural

Answer 4

Epidural: above dura, under skull
Medical emergency!
Is usually rupture of middle meningeal artery
Herniation
Loss of consciousness
Focal neuro deficits 
pupil dilation, paralysis of extremity

Question 5

hemorrhage head injury *subdural

Answer 5

below dura, between dura and brain
Usually venous
May be acute, subacute, chronic (elderly, people on anticoagulants)

Question 6

hemorrhage head injury

* intracerebral

Answer 6

within the brain tissue
Result of focused injury or system issues (hypertension → CVA)
Hemorrhagic stroke

Question 7

concussion

Answer 7

Global, microscopic
Widespread, homogeneous impairment of brain cells
Cells under-perform
Cells are “stunned”
No visible bleeding
Confusion, irritability, disorientation, headache
Post-concussion syndrome can last up to a year

Question 8

symptoms of a concussion

Answer 8

Confusion, irritability, disorientation, headache

Question 9

contusion

Answer 9

Localized, macroscopic
“Surface bruise” on the brain
Structural damage to cells
Cells die
Effects peak 18 – 36 hours after injury 
“Coup-contrecoup”
Can cause ↑ ICP d/t bleeding
Damage at brain cell level is not dependent on actual injury. You could be unlucky enough to have both as a result of same injury

Question 10

symptoms of a contusion

Answer 10

Blurred vision, disorientation, unsteady gait, vomiting, slurred speech, coma

Question 11

coup-contrecoup

Answer 11

Coup: damage that occurs right underneath the point of impact
Contrecoup: brain sits on the brain stem, rebounds backwards, opposite point of impact
Associated with contusions, focal injury

Question 12

diagnosis of concussion/contusion

Answer 12

CT or MRI
Identifies/evaluates injury to brain tissue
Skull x-rays
Penetrating injuries to the skull
Angiography
Is blood getting everywhere in the brain??